[Double gloving during orthopaedic procedures--possible discomfort or a right choice]

In the light of the increasing number of infections with hepatitis viruses and HIV, world wide as well as among the health care workers, the prevention of occupationally acquired infections in the operating room environment becomes crucial. Three plausible strategies do not require any knowledge of the exact mechanisms of exposure: vaccination, impenetrable protective barriers and post exposure prophylaxis (PEP). As HIV and HCV vaccine are not currently available, as some of the surgeons avoid the immunisation against hepatitis B as well as PEP in the context of HIV and HBV - appropriate barrier precautions (e.g. gloves, gowns and face shields) remain the last realistic alternative. According to multiple studies the authors present clear arguments for double gloving during surgical procedures. The perforation rates for single gloves or outer gloves are a few times higher than for double-inner gloves. It is concluded that double gloving is an essential element to prevent blood-borne infections at the operating room environment, especially during long-lasting, complex procedures combined with a large amount of blood loss. Possible reduce of sensitivity and manual dexterity may be improved by choosing more suitable combination of inner- and outer-glove size.